<%inherit file="base.html" />

<%def name="head()">
##    ${form.media}
</%def>

<%def name="content()">
    <h2>Myotonic Dystrophy Questionnaire</h2>

% if family_name:
    <div class='patient'>Questionnaire for <span class='familyname'>${family_name}</span>, <span class='givennames'>${given_names}</span></div>
% endif

    <div class='requirednote'>
        <span>Note:</span> All fields in <span>BOLD</span> are required
    </div>

    <form method="POST">
% for label, form, save in forms:

        <div class='subform'>
            <div class='label'>${label}</div>
            <div class='content'>${self.output_form(form)}</div>
        </div>
% endfor
        ## FJ MD Questionnaire item 7
        <input type="submit" value="Submit">
    </form>
</%def>
